Consumers are sometimes confused about their eligibility for Medicare, Medicaid, and marketplace programs.
Medicare is available to individuals 65 years old, or those who are receiving Social Security disability benefits after a two-year waiting period. Once eligible for Medicare, most consumers are automatically enrolled in free Part A (hospitalization coverage), but need to elect to enroll in Part B (major medical coverage) and should do so right away. Late enrollment in Medicare Part B can incur late fees and penalties, or a gap in coverage until the following year’s open enrollment period for Medicare.
Once eligible for Medicare on the basis of age, consumers are no longer eligible for financial assistance for a private health plan through the marketplace. There is an exception for consumers who are not eligible for premium-free Medicare Part A due to work history/recent immigration status.
If a consumer is enrolled in Medicare, they should not be offered a private health plan. If a consumer is eligible, and not enrolled, they may apply for coverage through the marketplace, but will not be eligible for financial assistance (absent the exception noted above). In most cases, individual coverage would be prohibitively expensive.
Consumers already enrolled in a private health plan when they become eligible for Medicare will lose financial assistance. In some cases, these individuals may lose coverage altogether when it comes time to renew their health plan if the insurance company has reason to believe they are enrolled in duplicate coverage. At present, this applies to CareFirst enrollees only on Maryland Health Connection.
Sometimes low-income consumers enrolled in Medicare seek additional help in covering their Medicare Part B and out-of-pocket costs. There are Medicare Savings programs available to assist these consumers, the most common of which are Quimby (QMB) and Slimby (SLMB). QMB recipients can also get assistance for pharmacy costs. Note that these programs are asset as well as income tested. These are not available through Maryland Health Connection. Consumers should apply with their local department of social services.
Consumers under age 65 receiving social security benefits based on disability and those who are in the two-year waiting period for Medicare may apply for coverage through the marketplace and receive financial assistance with private health plans.
Consumers in Medicaid eligible programs may also face changes when they reach 65. The expanded Medicaid group, or Modified Adjusted Gross Income (MAGI) Medicaid, offered through Maryland Health Connection, is available for consumers age 19 to 65. Once Medicaid enrolled consumers turn 65, they are no longer eligible for coverage through Maryland Health Connection unless they are parent or caretaker of a relative and have a lower income threshold of 123 percent of federal poverty levels (FPL).
Consumers becoming eligible for Medicare can get assistance through the Senior Health Insurance Program (SHIP), which has counselors in every county.